Delivery forceps

ABSTRACT

A method and apparatus for assisting in the delivery of a fetus from a womb which includes surrounding the upper portion of the head of the fetus with a plurality of flexible fingers contoured generally to the shape of the fetus&#39;&#39;s head and securing the fingers to the fetus and then applying a pull to the fingers to assist in the delivery of the fetus from the womb. A thin membrane may be provided to interconnect the fingers whereby a vacuum may be applied to further secure the fingers and membrane to the head of the fetus.

United States Patent Vennard et a1;

1 Feb. 26, 1974 DELIVERY FORCEPS [75] Inventors: William 0. Vennard;Arthur L.

Decker, both of Baton Rouge, La. [73] Assignee: Ethyl Corporation,Richmond, Va.

[22] Filed: Oct. 20, 1971 21 Appl. No.: 190,779

52 us. Cl. 128/352 [51] Int. Cl A6lb 17/44 [58] Field of Search...128/352, 353, 323, 324, 303, 128/345, 361

[56] References Cited 1 UNITED STATES PATENTS 549,904 11/1895 Dunbar....128/352 2,227,673 1/1941 Price 128/352 3,592,198 7/1971 Evans 128/3523/1940 Torpin 128/361 8/1965 Wood et a1. 128/361 [5 7] ABSTRACT 3 Amethod and apparatus for assisting in the delivery of a fetus from awomb which includes surrounding the upper portion of the head of thefetus with a plurality of flexible fingers contoured generally to theshape of the fetuss head and securing the fingers to the fetus and thenapplying a pull to the fingers to assist in the delivery of the fetusfrom the womb. A thin membrane may be provided to interconnect thefingers whereby a vacuum may be applied to further secure the fingersand membrane to the head of the fetus.

11 Claims, 10 Drawing Figures PAIENIE FEB26 I974 sum 1 or 5 PATENTH]FEB26 I974 SHEET L 0F 5 FIG. 5.

FIG. 4.

PATENTED FEBZB I974 SHEET 5 0F 5 vial/ ill,

DELIVERY FORCEPS BACKGROUND OF THE INVENTION 1. Field of the InventionThis invention relates, in general, to a method and apparatus forassisting in the delivery of a fetus from a womb.

2. Description of the Prior Art Obstetrical delivery forceps currentlyin use for assisting in the delivery of a fetus from a womb,particularly a human fetus, have changed little since their inception.These forceps are rigid, metallic devices which require insertion intothe vagina and contacting directly the head of the fetus with rigidmetal surfaces. One of the primary disadvantages of the presently usedforceps is that they are capable of applying intense pressure over avery small area on both' sides of the head of the fetus and only in onedirection. Unless the physician is extremely careful, excessive pressurecan be applied to the areas of the childs head in contact with theforceps resulting in some type of injury to the brain of the child, alsoeyes, ears, facial nerves, etc. Due to the sharp edges of the currentforceps, if the physician is not extremely careful, he may cause damageto the soft tissues of the mothers pelvis.

While some efforts have been made to develop new methods and apparatusesfor assisting in the delivery of a fetus from a womb, no significantpractical acceptance by obstetricians of the new techniques orapparatuses has taken place. U.S. Pat. No. 1,782,814 discloses aflexible envelope structure adapted to be placed over the head of afetus. Due to the flexible construction, it would be very difficult toposition the device around the foetal head while the fetus is stillwithin the womb. A vacuum-assist, obstetrical, caplike device isdisclosed in U. S. Pat. No. 2,194,989. The thick walls of this devicewould appear to prevent its collapse to a size permitting insertion intothe vagina to surround the foetal head. A cervical dilator withexpandable arms is disclosed in U. S. Pat. No. 3,312,222. The arms areadapted to dilate the cervical opening to assist in the delivery of thefetus. In U. S. Pat. No. 3,592,198 there is described an apparatuswherein a flexible plastic envelope is molded to the contour of thefoetal head, rigiditied by circulating a coolant therethrough, and thenused to apply a pull to the fetus to assist in delivery. While theapparatus represents an advance over the formerly used metal forceps,the apparatus required is complicated and expensive and also requiresthe use of a high degree of skill in placing the device on the head ofthe fetus and controlling its shaping to the foetal head.

Therefore, it can be seen that there is a need in the medical field fora new method and apparatus for assisting in the delivery of a fetus froma womb which will provide a simple apparatus that does not require muchskill to apply and will not cause injury to the head of the fetus orinjury to the soft tissues of the mothers pelvis.

SUMMARY OF THE INVENTION It is an object of the present invention toprovide a method and apparatus for assisting in the delivery of a fetusfrom a womb.

It is a further object of the present invention to provide an apparatusfor assisting in the delivery of a fetus from a womb which is relativelysimple to construct and to operate.

It is also an object of the present invention to provide an apparatusfor assisting in the delivery of a fetus from a womb wherein a securehold can be obtained upon the head of the fetus without damaging anyfoetal parts.

It is still another object of the present invention to provide anapparatus for delivering a fetus from a womb which can be sterilized andreused or discarded.

It is a still further object of the present invention to provide anapparatus for delivery of a fetus from a womb wherein the amount ofpressure applied to the head of the fetus can be carefully controlled toprevent damage to the foetal parts.

The foregoing objects are realized in a method for assisting in thedelivery of a fetus from a womb comprising surrounding the upper portionof the head of a fetus with a plurality of conforming, resilientfingers; securing the fingers tightly to the head of the fetus; andapplying a limited pulling force to the fingers to assist in thedelivery of the fetus from the womb.

The apparatus aspects of the present invention are realized in anapparatus which includes means to retain a plurality of flexible fingersin a collapsed state, means to extend the fingers to surround the headof the fetus, and means to secure the fingers to the head of the fetus.

The method and apparatus of the present invention overcome many of thedisadvantages found in obstetrical forceps used heretofore to assist inthe delivery of a fetus from a womb. The present method insures that auniform, evenly distributed pressure is applied to the head of thefetus, thus, obviating the dangers of localized high pressure andsubsequent damage of the childs brain. Additionally, the apparatus ofthe present invention is adapted to be securely attached to the head ofthe fetus through remotely controlled means whereby even and uniformpressure is applied to the head of the fetus.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. I is a perspective, isometric,elevational view of the reproductive portion of a human female showing afetus in position with the apparatus of the present invention secured tothe head of the fetus;

FIG. 2 is a perspective, elevational, partially broken and sectionalview of the obstetrical delivery apparatus of the present invention;

FIG. 3 is an elevational view of the obstetrical delivery apparatus ofthe present invention;

FIG. 4 is an elevational view, partially in section, of the obstetricaldelivery apparatus of the present invention having the fingers in theextended position;

FIG. 5 is an elevational view similar to FIG. 4 showing the flexiblefingers in the retracted position;

FIG. 6 is a cross-sectional view taken along line 6-6 of FIG. 3;

FIG. 7 is a cross-sectional view taken along line 77 of FIG. 3;

FIG. 8 is an enlarged, cross-sectional view of the portion of theapparatus of the present invention showing the flexible finger carryingthe retractor cord;

FIG. 9 is an enlarged, sectional view taken along line 9-9 of FIG. 6;and

FIG. 10 is an enlarged, elevational view of the upper end of one of thefingers of the apparatus of the present invention.

DESCRIPTION OF THE PREFERRED EMBODIMENTS Referring now to FIG. 1, thereis depicted a human female, designated generally 15, in the positionnormally assumed during childbirth. The fetus or child, designatedgenerally 16, is positioned in the uterus or womb 17 with its head 18 inthe normally downwardly directed position. The obstetrical deliveryapparatus of the present invention, designated generally 19, is held inthe left hand 20 of the physician, and the right hand 21 is used tooperate the device after placement of the apparatus within the wombopening.

Referring now to FIGS. 25, the delivery apparatus 19 includes anelongated, hollow support body or housing 22. The housing is hollow andprovides an elongated bore 23 which extends therethrough. The lower endof the housing 22a abuts U clamp spacer 27. The housing 22 is slidablyreceived over sleeve member 26. The lower end 26a of the sleeve isreceived in a recess 24 provided in the head member 25. The lower end26a of the sleeve is fixedly retained in the recess 24 provided in thehead member by means of silver solder or other suitable means. U clampspacer 27 which is attached by bolts 28 to sleeve member 26 can beremoved, if desired, to provide a greater extension of flexible fingers.A pair of handles 30-30 are attached to the head member 25 by havingtheir inner ends' 31-31 threadably received in threaded bores 32-32provided in opposite sides of the head member.

As seen in FIGS. 2, 4, 5, 8 and 9, the sleeve 26 is generallycylindrical and makes a close sliding fit within the bore 23 of thehousing 22. The upper end 26b of the sleeve provides a cylindrical bore33 extending therethrough. As seen more clearly in FIG. 2, the sidewallsof the sleeve 26 are provided with opposed, longitudinal slots 34-34.

A guide rod 35 is axially received within the bore 33 of the upper end26b of the cylindrical sleeve 26. rings (not shown) may be provided toinsure a good vacuum seal between the upper end of guide rod 35 and thethickened upper end portion 26b of the sleeve 26, if desired. The upperterminal portion 35a of guide rod 35 has a larger diameter than theintermediate portion and is provided with an outwardly flared tipportion 36 which extends above the end of the housing or body 22. Thelower end 35b of the guide rod 35 is threaded and received in a threadedbore 37 provided in one end of the vacuum control block 38, as seen inFIG. 7. The guide rod 35 is provided with an axial bore 39 which extendsfrom the vacuum control block 38 to the opening in its upper tip portion36.

Housing 22 is fixedly connected to guide rod 35 by means of pins 40-40which pass through an opening provided in slide blocks 41-41 which arereceived in the slots 34-34 provided in the sleeve 26.

The upper end 26b of sleeve 26 has attached thereto a plurality ofpreset, arcuate-shaped, flexible, metal or plastic fingers or springmembers 42. These fingers are interconnected by means of a thin,flexible, collapsible member 43 which is made from rubber or plastic orother suitable material. The outer end of each of the fingers or springmembers 42 is provided with a transverse opening 44 therein, as can bemore clearly seen in FIG. 10. A cord 45 passes through each of theopenings 44 in the fingers to connect all of the fingers together attheir outer ends. One end of the cord is secured to finger 42a, as seenin FIG. 2, and the other end of the cord passes through a channel oropening 46 which is provided within the hollow finger 42a. As can beseen more clearly in FIGS. 8 and 9, the sleeve 26 is provided with alongitudinal slot 47 which provides a passageway for the lower end 45aof the cord 45. The lower end 45a of the cord passes through an openingprovided in the head member 25 and is attached to take-up reel 48 whichis positioned within a slot 49 provided in head member 25. Take-up reel48 is fixedly mounted on rotatable shaft 50 positioned in transverseopenings provided in the body 25. Cord 45a can be wound on the reel byrotating thumb screw 51 attached to the outer end of shaft 50. A ratchetmechanism, designated generally by the numeral 52, is provided on theother end of shaft 50 and locks the reel 48 against unwinding. Ratchetmechanism 52 includes a toothed wheel 53 which is fixed to the end ofshaft 50 opposite thumb screw 51 and is received in a bore 54 providedin the side of head member 25. An elongated locking key 55 is slidablyreceived in a bore which extends through head member 25 and intersectsthe bore 54 provided on the side thereof. The locking key contains adetent arm (not shown) which engages the toothed wheel 53 to preventcounterclockwise rotation of the cord take-up reel 48 until the outerend 56 of the locking key 55 is depressed. Spring 57 is received in anenlarged portion of the bore extending through the head 25 which carrieslocking key 55. This spring abuts a collar 58 which is an integral partof the rod 55 and urges the rod 55 toward the outer end 56 in normaloperation. The collar 58 is retained against outward movement within thebore by means of a hollow locking screw 59 which is threadably receivedin the bore carrying the key 55.

Referring now to FIG. 7, the vacuum control block, designated generallyby the numeral 38, is provided with a series of valves and channels forapplying vacuum to the space between the fetuss head 18 and thefinger-supported membrane 43 by means of the bore 39 provided in theguide rod 35. An axial extension bore 60 is provided in the block 38which connects to the bore 39 provided in guide rod 35. Axial bore 60 isintersected by transverse bore 61 which extends through the body 38 andis sealed by means of cap screws 62-62 at each end thereof. A bore 63and an offset recess 64 are provided in the block 38 and contain avacuum check valve which includes the valve seat 65, check valve ball66, compression spring 67 and vacuum plug 68. Plug 68 is threadablyreceived in a threaded portion of the recess 64 and is provided with acentral cylindrical extension 69 to which may be attached a hypodermicsyringe 70 shown in dotted outline in FIG. 7. A bore 71 connects thevacuum recess 64 to the exhaust recess 72. The exhaust recess containsan exhaust check valve which includes a seat 73, check valve ball 74,retainer spring 75 and exhaust plug 76. The lower end 35b of guide rod35 is retained in the block 25 by means of a set screw 77 received in athreaded bore 78.

In utilizing the apparatus of the present invention to assist inchildbirth, the physician first places the instrument in the positionshown in FIG. 5 of the drawings, that is, the head member 25 is movedrearwardly to the position where its lower face is in abutment with theupper face of the vacuum block 38. In this position the fingers 42 areretracted within the housing 22 and are placed in a generally parallelposition within the cavity provided between the housing 22 and the guiderod 35. The physician holds the instrument in his left hand, as seen inFIG. 1, and places the outer tip portion 36 of the instrument againstthe crown of the head of the fetus through the vaginal opening. With hisright hand, the physician then grasps one of the handles while holdingthe tip 36 firmly in position against the fetus's head. He then movesthe sleeve 26 forward in housing 22 by pushing forward on handle 30until the flexible fingers 42 are moved forward out of the space betweenthe body 22 and guide rod and assume the position shown in FIG. llsurrounding the head of the fetus. The physician tightens the nooseportion of the cord 45 by rotating the thumb wheel 51 of the cordtake-up mechanism to lock the tips of the flexible fingers 42 securelyto the head of the fetus and then pumps the plunger of the hypodermicsyringe 70 a sufficient number of strokes to create a vacuum between themembrane 43 and the head of the fetus to securely bind the membrane tothe head of the fetus. Having securely attached the apparatus to thehead of the fetus, the physician then pulls back on the handles 3030 ofthe apparatus with the proper force to assist in the delivery of thefetus from the womb. After delivery has progressed to the point wherethe head of the fetus is outside of the mothers body, the apparatus maybe removed from the head of the fetus by depressing the tip 56 of rod ofthe ratchet mechanism thereby releasing the cord tension and relievingthe vacuum by turning the thumb screw 80, thus permitting the fingers tobe retracted back into the apparatus by pulling back on the handles 3030and retracting the fingers to the position shown in FIG. 5. Slots 79 inthe tip 36 of the guide rod facilitate applying and releasing vacuumbetween the fetuss head and the membrane 43.

The delivery apparatus of the present invention can be convenientlyfabricated from stainless steel or other metals which arecorrosion-resistant and capable of sterilization and reuse. However, theapparatus may be formed in part or substantially completely from plasticparts whereby the apparatus may be used one time and discarded. If theapparatus is constructed from steel or stainless steel or other metals,it may be disassembled for cleaning and autoclaving and subsequentlyreused.

While there has been described what is the preferred embodiment of thepresent invention, it will be obvious to those skilled in the art thatvarious modifications can be made thereto which are still within thescope of the invention. For example, an automatic vacuum relief valvemay be provided in the vacuum control block 38 at one end of bore 61whereby the vacuum may be limited to a preset maximum value toautomatically limit to a predetermined value the total force or pullapplied to the fetus. When operated in this manner, the noose portion ofthe cord 45 would not be tightened. Other modifications will be obviousto those skilled in the art. The invention is to be limited only by thescope of the following claims.

What is claimed is: l. In an apparatus for assisting in delivery of afetus from a womb, the combination comprising:

a. housing means including an elongated hollow body having acylindricalbore therein; b. a generally cylindrical sleeve slidablyreceived in said body;

c. a plurality of flexible fingers attached to one end of said sleeve,said fingers being extendable from and retractable into said body byrelative movement between said body and said sleeve;

d. a guide rod axially received within said body and said sleeve, andhaving means at one of its ends for flaring outwardly said fingers whensaid fingers are extended from saidlbody; asaj w e. means to secure saidfingers to said head of said fe- 2. In the apparatus of claim I whereinsaid securing means includes a cord having a noose portion connected tosaid fingers.

3. In the apparatus of claim 1 wherein said securing means includes acontinuous, thin, flexible membrane connecting all of said fingers.

4. In the apparatus of claim 1 wherein said securing means includes acord having a noose portion connected to the outer ends of said fingersand a continu ous, thin, flexible membrane connecting all of saidfingers.

5. In the apparatus of claim 2 wherein means to tighten said noose isprovided.

6. In the apparatus of claim 3 wherein means are provided for evacuatingthe space between said membrane and said head of said fetus to securelyattach said membrane and said fingers to said head of said fetus.

7. In an apparatus for assisting in the delivery of a fetus from a womb,the combination comprising:

a. an elongated support body having an axial bore extendingtherethrough;

b. a guide rod having a diameter smaller than said bore fixedly, axiallypositioned within said bore and having at least one end extendingoutwardly therefrom;

c. a sleeve slidably mounted on said guide rod for movement into and outof said bore in said body;

d. a plurality of flexible fingers attached at their inner ends to oneend of said sleeve, said fingers adapted to be received substantiallywithin the bore of said body when said sleeve is moved to a positionsubstantially outside said body and to be extended from said body whensaid sleeve is received substantially within said body;

e. a continuous, thin, flexible membrane connecting all of said fingers;

f. a cord having a noose portion connected to the outer ends of saidfingers and a terminal portion extending through the bore in said body;and

g. a windlass assembly carried by the outer end of said guide rod andconnected to the terminal end of said cord for tightening said cord tosecure said fingers to said head of said fetus.

8. In the apparatus of claim 7 wherein said guide rod is provided with abore therethrough for evacuating the space between said membrane andsaid head of said fetus.

9. In the apparatus of claim 7 wherein said sleeve is provided with aplurality of elongated slots and said body is connected to said guiderod by means of spacer blocks slidably received in said slots in saidsleeve.

10. In the apparatus of claim 7 wherein the end of said guide rodadjacent said fingers is provided with an outwardly flaring surface.

11 In the apparatus of claim 7 wherein one of said fingers is providedwith a bore therethrough which receives a part of said terminal portionof said cord.

m m m 4 4t

1. In an apparatus for assisting in delivery of a fetus from a womb, thecombination comprising: a. housing means including an elongated hollowbody having a cylindrical bore therein; b. a generally cylindricalsleeve slidably received in said body; c. a plurality of flexiblefingers attached to one end of said sleeve, said fingers beingextendable from and retractable into said body by relative movementbetween said body and said sleeve; d. a guide rod axially receivedwithin said body and said sleeve, and having means at one of its endsfor flairing outwardly said fingers when said fingers are extended fromsaid body; and e. means to secure said fingers to said head of saidfetus.
 2. In the apparatus of claim 1 wherein said securing meansincludes a cord having a noose portion connected to said fingers.
 3. Inthe apparatus of claim 1 wherein said securing means includes acontinuous, thin, flexible membrane connecting all of said fingers. 4.In the apparatus of claim 1 wherein said securing means includes a cordhaving a noose portion connected to the outer ends of said fingers and acontinuous, thin, flexible membrane connecting all of said fingers. 5.In the apparatus of claim 2 wherein means to tighten said noose isprovided.
 6. In the apparatus of claim 3 wherein means are provided forevacuating the space between said membrane and said head of said fetusto securely attach said membrane and said fingers to said head of saidfetus.
 7. In an apparatus for assisting in the delivery of a fetus froma womb, the combination comprising: a. an elongated support body havingan axial bore extending therethrough; b. a guide rod having a diametersmaller than said bore fixedly, axially positioned within said bore andhaving at least one end extending outwardly therefrom; c. a sleeveslidably mounted on said guide rod for movement into and out of saidbore in said body; d. a plurality of flexible fingers attached at theirinner ends to one end of said sleeve, said fingers adapted to bereceived substantially within the bore of said body when said sleeve ismoved to a position suBstantially outside said body and to be extendedfrom said body when said sleeve is received substantially within saidbody; e. a continuous, thin, flexible membrane connecting all of saidfingers; f. a cord having a noose portion connected to the outer ends ofsaid fingers and a terminal portion extending through the bore in saidbody; and g. a windlass assembly carried by the outer end of said guiderod and connected to the terminal end of said cord for tightening saidcord to secure said fingers to said head of said fetus.
 8. In theapparatus of claim 7 wherein said guide rod is provided with a boretherethrough for evacuating the space between said membrane and saidhead of said fetus.
 9. In the apparatus of claim 7 wherein said sleeveis provided with a plurality of elongated slots and said body isconnected to said guide rod by means of spacer blocks slidably receivedin said slots in said sleeve.
 10. In the apparatus of claim 7 whereinthe end of said guide rod adjacent said fingers is provided with anoutwardly flaring surface.
 11. In the apparatus of claim 7 wherein oneof said fingers is provided with a bore therethrough which receives apart of said terminal portion of said cord.